Tony Ogburn, MD, District VIII legislative chair
District VIII was well represented at the ACOG State Legislative Roundtable in Washington, DC, September 20–21. Emerging issues within the states include substance abuse, environmental health, and immunizations. Neonatal abstinence syndrome is an increasing problem. ACOG’s position on substance abuse is outlined in the Committee Opinion “Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician-Gynecologist.” Public health approaches should be supported, not law-and-order approaches.
Patient exposure to toxic environmental chemicals and other stressors is another issue gaining momentum. ACOG released the Committee Opinion “Exposure to Toxic Environmental Agents” shortly after the State Legislative Roundtable concluded. Additional resources can be found on the ACOG website.
Patient refusals of immunizations have been on the rise. It’s important to educate patients and make sure you and your staff are vaccinated. Immunization news, information, resources, and tools for providers and patients are available on the ACOG Immunization for Women website.
Ongoing issues in the states include breast density notification legislation, lay midwife practice, maternal mortality, and health care reform. A number of states have considered or passed laws regarding notification and/or evaluation of women if their mammogram shows they have dense breasts. ACOG members have been working with state legislators on the language of such bills to address flaws and include standard of care language.
Lay midwife practice continues to concern some states. There has been a wide range of approaches, from outlawing their practice to working with them. The outlaw approach has not been successful. Members present at the State Legislative Roundtable felt the goal should be to better regulate their practice with competency standards and licensure.
Maternal mortality review looks like it will remain a state issue for the foreseeable future. For some states, getting records from hospitals to review can be a challenge. Montana recently added maternal morality review to its already existing committee structure. This issue may be something to include in perinatal collaborative efforts.
The effect health care reform will have on you and your patients depends on the state where you practice. It will undoubtedly provide many protections for women, including contraceptive coverage, elimination of preexisting condition restrictions, and preventive health services, to name a few. However, there are differences among states that will expand or alter coverage for many patients. All states will have an insurance exchange program. Some states are developing their own while others have opted to allow the federal government to run their program.
Patients with incomes on a sliding scale of 133% to 400% of the federal poverty level (FPL) will receive assistance to purchase coverage. States can choose to participate in Medicaid expansion, which will cover patients with incomes up to 133% of FPL (approximately $15,000 for an individual and $33,000 for a family of four per year). It is anticipated that more than 17 million women will gain coverage from health care reform. I encourage you to make sure you understand how reform will be implemented in your state and be prepared to assist patients with the transition. The ACOG State Legislative Activities website has helpful resources available.
Attempts to restrict reproductive health services continue across the country. There was a lively discussion at the meeting about this topic. Unfortunately, the tactics of the anti-choice community continue to expand. Albuquerque, NM, included a city ordinance on its ballot banning abortions after 20 weeks of pregnancy this fall. Thankfully, the ordinance was rejected by voters.
I encourage everyone to get involved in protecting our patients’ rights and preserving the patient-physician relationship. Don’t expect someone else to do it! In particular, we need members who are willing to testify before legislatures and talk to legislators. District VIII sections host a number of lobbying events throughout the year. Contact your section officers if you’d like to get involved.
The 2014 Congressional Leadership Conference (CLC) will be held March 2–4, and the District VIII legislative meeting will be on the morning of March 2. This meeting continues to be popular and successful. I hope you will plan to join us this year. All District VIII CLC attendees are welcome to attend the District VIII meeting! Please consider sponsoring a medical student and/or resident to attend the CLC. It’s a great experience for them.